Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates
Received 20 March 2009; received in revised form 12 May 2009; accepted 14 May 2009.
Purpose
To determine whether institution of a structured surgical curriculum for ophthalmology residents decreased the rate of sentinel surgical complications.
Setting
Veterans Affairs Medical Center, Des Moines, Iowa, USA.
Methods
A retrospective review was performed of third-year ophthalmic resident quality-assurance surgical outcomes data at a single residency-training site from 1998 to 2008. The primary outcome measure was defined as a sentinel event; that is, a posterior capsule tear (with or without vitreous loss) or vitreous loss (from any cause) occurring during a resident-performed case. The study population was divided into 2 groups. Group 1 comprised surgical cases of residents trained before the surgical curriculum change (academic years 1998 to 2003) and Group 2, surgical cases of residents trained with the enhanced curriculum (academic years 2004 to 2008). Data from 1 year (academic year 2003 to 2004) were excluded because the transition to the enhanced curriculum occurred during that period. The data were analyzed and adjusted for surgical experience.
Results
In Group 1 (before institution of surgical curriculum), there were 823 cases with 59 sentinel complications. In Group 2 (after institution of surgical curriculum), there were 1009 cases with 38 sentinel complications. There was a statistically significant reduction in the sentinel complication rate, from 7.17% before the curriculum changes to 3.77% with the enhanced curriculum (P = .001, unpaired 2-tailed t test).
Conclusion
Implementation of a structured surgical curriculum resulted in a statistically significant reduction in sentinel event complications, even after adjusting for surgical experience.
From the Department of Ophthalmology (Rogers, Oetting, Lee, Grignon, Greenlee, Johnson, Beaver, Carter), University of Iowa Hospitals and Clinics, and Veterans Affairs Medical Centers, Iowa City (Oetting, Greenlee), and Des Moines (Grignon), Iowa, USA
Corresponding author: Thomas A. Oetting, MS, MD, Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP, Iowa City, Iowa 52242, USA.
No author has a financial or proprietary interest in any material or method mentioned.
Dr. Lee is a member of the Residency Review Committee for Ophthalmology of the Accreditation Council for Graduate Medical Education. The opinions expressed here do not represent those of either entity.
Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, USA.
Richard Olson, MD, H. Culver Boldt, MD, Michael Abramoff, MD, PhD, and other members of the Iowa Task Force for the Competencies, provided support and guidance. Linda Aycock provided the quality-assurance outcomes data. Ed Colloton, MD, volunteered to teach the residents in the wet laboratory. Patricia Duffel, Randy Verdick, and Laura Pitlick provided support of resident training.
ABSTRACT